Deleterious Effects of Increased Intra-Abdominal Pressure on Kidney Function

Abstract

Elevated intra-abdominal pressure (IAP) occurs in many clinical settings, including sepsis, severe acute pancreatitis, acute decompensated heart failure, hepatorenal syndrome, resuscitation with large volume, mechanical ventilation with high intrathoracic pressure, major burns, and acidosis. Although increased IAP affects several vital organs, the kidney is very susceptible to the adverse effects of elevated IAP. Kidney dysfunction is among the earliest physiological consequences of increased IAP. In the last two decades, laparoscopic surgery is rapidly replacing the open approach in many areas of surgery. Although it is superior at many aspects, laparoscopic surgery involves elevation of IAP, due to abdominal insufflation with carbonic dioxide (pneumoperitoneum). The latter has been shown to cause several deleterious effects where the most recognized one is impairment of kidney function as expressed by oliguria and reduced glomerular filtration rate (GFR) and renal blood flow (RBF). Despite much research in this field, the systemic physiologic consequences of elevated IAP of various etiologies and the mechanisms underlying its adverse effects on kidney excretory function and renal hemodynamics are not fully understood. The current review summarizes the reported adverse renal effects of increased IAP in edematous clinical settings and during laparoscopic surgery. In addition, it provides new insights into potential mechanisms underlying this phenomenon and therapeutic approaches to encounter renal complications of elevated IAP.

Evaluation of the Diagnostic Accuracy of Intra-Abdominal Pressure Measurement Method Through Bladder in Predicting Renal Dysfunction After Kidney Transplantation

“…acute IAP increase has adverse effects on the cardiovascular system, reduces the cardiac output and venous return and blood ow to the mesenteric vein, stimulates the renin-angiotensin system, and consequently, contraction of the arterioles and renal vein, reduction of renal blood ow, and increase of the hydrostatic pressure of the Bowman's capsule that, in turn, reduces the glomerular ltration rate and decreases the urine volume. According to various studies, an inverse correlation has been found between higher IAP and urine volume (13,16).…”

Role of intra-abdominal pressure in early acute kidney injury: A prospective cohort study in critically Ill obstetric patients

“…Increase in IAP is known to affect the renal function adversely. [ 4 10 11 12 ] Demarchi et al recently noted IAP values of >8 mmHg to predict the development of AKI. [ 13 ] Contrastingly, we noted a lack of effect of IAP on early AKI when evaluating the relationship in critically ill obstetric patients.…”

“…[ 4 ] It is documented that not only IAH but even moderate rise in IAP of 8 mmHg or greater can be associated with deterioration in renal functions. [ 4 ] To diagnose an acute deterioration in renal function serum creatinine and/or urine output are conventionally relied on and be nonspecific as well. However, both these parameters are known to change late in the course of renal insult.…”

Mediators of Regional Kidney Perfusion during Surgical Pneumo-Peritoneum Creation and the Risk of Acute Kidney Injury—A Review of Basic Physiology

“…Urinary nitric oxide metabolites are increased in compensated, but not in decompensated, chronic heart failure induced by establishing an artificial aorto-caval fistula in rats, implicating that this mechanism becomes exhausted with advancing heart failure [ 118 , 119 ]. Regrettably, the anatomical relationship between the aorto-caval fistula and renal vessels (whether infra- or suprarenal) was not communicated in the latter publications [ 118 , 119 ]. The deterioration of RPF was less pronounced in the compensated heart failure group than in the control group at 10 and 14 mmHg.…”

“…The administration of a nitric oxide synthase inhibitor eliminated the beneficial effect and RPF became worse than in the control group with attenuated parallel changes in GFR [ 118 , 119 ]. Hyper-perfusion and a proportionally (about 60%) increased GFR were observed in the control group after the termination of insufflation.…”